y Chapter 4.1: Genital Ulcer, Population Reports, Series L, Number 9

CONTENTS

          Chapters
  1. The Toll of STDs
  2. Reducing the Toll of STDs
  3. Managing STDs
  4. Diagnostic and Treatment Tips
  5. Getting Services to the People
  6. Getting People to Services
  7. Promoting Prevention—Condoms and Monogamy

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXI, Number 1
June, 1993

Genital Ulcer

 Diagnostic Tips

  • Lesions of syphilis and chancroid vary in appearance and may be indistinguishable from one another. If a shortage of drugs makes treatment for both chancroid and syphilis impossible, however, try to distinguish between the two. Syphilis usually produces a single painless ulcer with firm borders that feel like the tip of the nose (36, 294). Chancroid usually produces a soft, painful ulcer with an irregularly shaped border. In women the chancroid ulcer may not be painful, however. Alternatively, providers may treat for the STD that is more common in the area.

  • Herpes ulcers usually differ from chancroid and syphilis ulcers. Herpes ulcers with a secondary bacterial infection, however, may resemble syphilis and chancroid ulcers.

  • Syphilis and chancroid may cause enlarged lymph nodes. In syphilis, lymph nodes are enlarged and firm but painless. In contrast, chancroid, like lymphogranuloma venereum (LGV), can cause enlarged and tender lymph nodes that may burst and leak pus (185, 283).

  • People with syphilis may not seek treatment until they have symptoms of secondary syphilis—rash, hair loss, sore throat, malaise, headache, weight loss, fever, or swollen lymph nodes (70, 294).

  • The rapid plasma reagin (RPR) test may be falsely negative in 25% to 50% of patients who have primary syphilis (128, 283). If the ulcer could be either chancroid or syphilis and the RPR is negative, the patient should be treated for syphilis anyway.

  • Donovanosis and LGV also cause genital ulcers. Donovanosis begins as nodules under the skin that erupt and form usually painless, sharply defined lesions. The lesions of LGV are small papules or shallow ulcers that look like herpes blisters and heal without treatment. LGV usually causes tender inguinal buboes that may leak pus. These buboes are the usual reason that people seek treatment (223, 283).

  • Patients may also have nonulcerative genital lesions caused by human papillomavirus (HPV) and molluscum contagiosum. Human papillomavirus causes genital warts (condylomata acuminata), which often look like a cauliflower. The lesions caused by molluscum contagiosum are white, smooth pimples that contain a white, cheeselike substance (283, 333).
Treatment Tips

  • Make every effort to treat syphilis because it has serious sequelae.

  • If possible, ask the patient to return for RPR tests 3, 6, and 12 months after the initial visit to confirm the cure.

  • Treatment for LGV is doxycycline, 100 mg orally, twice daily for 14 days; OR tetracycline, 500 mg orally, four times daily for 14 days (348).

  • Treatment for Donovanosis is trimethoprim, 80mg/sulfamethoxazole, 400 mg, or a comparable sulfonamide component, two tablets twice daily, orally for at least 14 days (348).

  • If a patient returns because a genital ulcer has not healed, HIV infection may be the reason (306). Refer the patient for testing.

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